Pancytopenia demystified: A proposed diagnostic algorithm for the strategic evaluation of pancytopenia

Objective: To design a simplified minimally invasive algorithm for strategic diagnostic approach towards pancytopenia by evaluating the etiological spectrum of pancytopenia in a tertiary care hospital. Material and Methods: It was a retrospective study which was conducted at Fauji Foundation Hospital Rawalpindi. The duration of study was 3 years, i.e. January 2022 - January 2025. Patients of both genders and all ages who were diagnosed as having pancytopenia were included in the study. All pancytopenia were verified on peripheral smear. Results of other diagnostic workup done to identify the etiology of pancytopenia including reticulocyte count, malarial parasite (MP), serum iron profile, vitamin B12 levels, red blood cell (RBC) folate, blood cultures etc. and of different imaging techniques were noted. Results: Out of total 216 patients 174 were females and 42 were male. Non-malignant cases in patients presented with pancytopenia were 181. Whereas 35 cases (16.2%) showed various malignant disorders. Among the non-malignant disorders, the most common etiology was infections (27%) followed by megaloblastic anemia (19%). In malignant disorders acute lymphoblastic and acute myeloid leukemia comprised the largest bulk (40%). Non-diagnostic marrows were 37%. After a thorough evaluation of generated data, a simplified algorithm is designed to opt for a strategic approach towards diagnosis of pancytopenia. Conclusion: Among various causes of pancytopenia, megaloblastic infections and aplastic anemia were the most common causes. Thorough and logical evaluation and strategic diagnostic approach following algorithm will help to reduce mortality and morbidity in patients presenting with pancytopenia. Keywords: Bone marrow examination, Malignant disorders, Pancytopenia.